Some comments related to the first paper referenced:THE 1st...

Some comments related to the first paper referenced:

THE 1st PAPER REFERRED TO
Title: Is long-axial field-of-view PET/CT cost effective? An international health economic analysisPublication: Journal of Nuclear Medicine June 2024, 65 (supplement 2) 242446.
(Found at: https://jnm.snmjournals.org/content/65/supplement_2/242446)

DEFINITIONS (See Fig 1 below)
A) SAFOV Short Axis Field of View
They cover up to 30cm at a time, meaning that to scan head to toe requires multiple patient movements, 30cm at a time. The movements needed add to the time. The average time to capture the images required is 16 minutes. SAFOV is the old equipment, so its used as a reference.
B) LAFOV: Long Axis Field of View
The new kid on the block. They cover a wider area, with the largest at 194cm allowing a head to toe in one picture (where TB = Total Body). The average time to capture images of SAFOV reference standard is under 2 minutes (1.5minutes with Fluorine tracer, and 2 minutes with the Gallium). The best image is at 10 minutes (this is better than 2 minutes).

Fig 1: SAFOV and LAFOV illustrations


INITIAL COMMENTS (on the paper)
1) Unfortunately, we only have an abstract on a supplement issue of the journal. I can not find the paper or the data. This matters because the results do not make sense (to me and to JD as well – as stated above). My observations are hence, provisional and contingent upon reviewing the complete study.
2) Because the results (and hence, the conclusions) do not seem to make sense (at present), it is not possible really to comment much further. So, I will just share the little I can deduce from it and stop there - almost!
3) I am keen to make one assumption though: What if they are right in the cost effectiveness argument? I say this because I note that the authors seem to be people of repute (Author 1 is quite prolific writer judging by his publication record on the matter). But I will dwell into those extra opinions and inferences on a different post – so as to avoid being confuser!

MAKING SENSE OF THE RESULTS
The results are presented below (my Fig 2)

Fig 2: SAFOV and LAFOV costs (per this paper)

a) Normal versus Extended Hours: I assume the increase in the per patient costs of Extended hours, from about US $850 to US$1250 on the SAFOV, and the corresponding increase from US$550 to US$750 is on the LAFOV was due to staff having to be paid more per hour for working unsocial hours? There may also be other reasons - workflows etc. I dont know. Although the magnitude of cost increases (US$400 for SAFOV versus US$200 for a LAFOV) is so different that it needs its own analysis. But, I am fine with that.

b) Single versus Two scanners: How does having a 2nd machine lead to an increase in the per patient cost, when the patient uses just one machine, not both? In life it's usually the opposite: 2 machines should share some costs (the fixed costs), as we do when we move in with a partner – even if one is forced to use the sofa due to snoring! The toilets, kitchens, car park, and some of the lighting are all shared in both situations. Even staff costs, like the supervisor and the likes, do not need to double up. More clarification needed here otherwise, what is the point!

c) Cost difference: Extracting the numbers from image (my Fig 2), and limiting the comparisons to a single machine, Single SAFOV vs Single LAFOV: the single SAVOV costs about US$850 per patient, versus about US $550 for a LAFOV, per patient. If the difference in the costs of purchase and instal was US$5million, it would take 16,666 scans to reach break even. I do not know how busy these centres are so this bit is for those who can expand on it. Suffice to say that this costing assumes a centre that currently has no machine and so, then need to buy one: SAFOV versus LAFOV.

Their Fig 2 (ICER: Incremental cost efficiency ratio) - I can not evaluate this since the baseline data is not available and does not seem to make much sense.

IN CONCLUSION
Without full data, I wouldn't read much into the information on this abstract. I will look for the full paper - if it gets published. Its possible that a longer document may exist if this was a poster at a conference. The fact it was on a supplement suggests so!

This is NOT investment advice!